P1607: QUALITATIVE PLATELET ABNORMALITIES AND MENORRHAGIA IN ADOLESCENTS AND WOMEN OF REPRODUCTIVE AGE. TEN-YEAR REFERRALS IN A TERTIARY HOSPITAL OF NORTHERN GREECE.
Authors: Stamatia Theodoridou, Aikaterini Teli, Genovefa Mantzou, Christina Karypidou, Alkistis Adramerina, Maria Vousvouki, Eleni Moka, Sofia Chissan, Eleni Gavriilaki, Marina Economou, Sofia Vakalopoulou
Journal: HemaSphere (2023)

Topic: 32. Platelet disorders Background: Menorrhagia occurs in a considerable percentage of the general population and is a leading reason behind the reference of women to healthcare services. It is the most common symptom for women with bleeding disorders and unexplained in more than 50% of cases. Menorrhagia seriously affects women’s and adolescents’ quality of life. Platelet function disorders constitute a rare cause of symptomatic bleeding, are heterogeneous, both in clinical expression and laboratory evaluation. Aims: 46 women (43 women/ 4 teens) of mean age 30.9 ± 9.1 years, were referred as suspected for platelet dysfunction since the other causes of menorrhagia, such as uterine-hormone related problems, thrombocytopenia, coagulation factor deficiencies and von Willebrand’s disease were excluded. Methods: The platelet function investigation consisted of: 1. the platelet number and mean platelet volume using an automated cell analyzer 2. blood film report for platelet size and white cell inclusions 3. aggregation testing in platelet rich plasma with light transmittance platelet aggregometry (LTG) by the use of 5 agonists (arachidonic acid, ADP, adrenaline, collagen, ristocetin) (helena Biosciences Europe). The usual limit of thrombocytopenia for performing platelet aggregometry is 100x109/ L. No medications and strict dietary conditions were given prior testing. In cases of abnormal responses, the test was repeated one month later and it was considered as abnormal when the deficit sustained on repetition. In addition to that, a clinical assessment of bleeding history with ISTH BAT score and family history for potential inheritance pattern was conducted. Results: All subjects were negative for coagulation factors deficiencies and thrombopenia and ten (21.7%) had Hb levels<12.5g/dl. The mean platelet count was 219 ± 79 x109/ L, while the mean BAT score was found 4.15 ± 1.68. Platelet aggregation was decreased with one or more agonists in 30 cases (65%), while the BAT score was abnormal (>6) in 5 cases (10,86%). The most common platelet aggregation defect was reduced aggregation to epinephrine (12 women with BAT score < 6 in all cases). The second most common decrease was in the combination of two agonists (epinephrine and collagen) (6 cases, while BAT score was abnormal in two cases (33.3 %). In 4 cases, impairment of aggregation with four agonists (ADP, epinephrine, collagen and Arachidonic Acid) and BAT score<6 was observed. In 3 cases, abnormal aggregation with ADP with BAT score <6 was detected. Abnormalities in platelet aggregation with the combination of epinephrine and ADP were found in 2 cases with BAT score<6, epinephrine and Arachidonic Acid in 2 cases with one case having BAT score>6 and a combination of Collagen and Arachidonic acid aggregation impairment in one case with BAT score of 5. 17 patients were diagnosed with platelet secretion and signal transduction disorders, 3 with aspirin like defect, 6 with collagen receptor abnormality and 4 had abnormal aggregation to several agonists. No abnormality was found in 16 cases, of which only 1 had BAT score of 7, with the rest of them having BAT score <6. They were characterized as bleeders of unknown cause. Summary/Conclusion: Μenorrhagia approach should be multidisciplinary. The prevalence of platelet disorders is underestimated. The phenotypic bleeding variation is the result of more than 70 genes which cause platelet function disorders. Regardless of the “normal or nearly normal” BAT scores, the investigation revealed several platelet function issues in women with menorrhagia. Nevertheless, women without a specific diagnosis continue having annoying bleedings, therefore the reduction of blood loss and the treatment of existing anemia are of the outmost priority. Email Address: [email protected] Keywords: Platelet function, Bleeding disorder, Bleeding, Platelet aggregation